prevalence and correlates of alcohol abuse and dependence in lebanon: results from the lebanese...

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Prevalence and Correlates of Alcohol Abuse andDependence in Lebanon: Results from the LebaneseEpidemiologic Survey on Alcohol (LESA)Jean-Claude Yazbek M.D. Psychiatrista, Ramzi Haddad M.D.b, Rami Bou Khalil M.D.c, SaniHlais M.D.d, Grace Abi Rizk M.D.d, Jihane Rohayem M.D.b & Sami Richa M.D. Ph.D.b

a Department of Psychiatry, Saint-Joseph University, Beirut, Lebanonb Department of Psychiatry, Saint-Joseph University, Beirut, ,c Department of psychiatry at Saint Joseph University, Beirut, Lebanond Department of Family Medicine, Saint-Joseph University, Beirut,Accepted author version posted online: 12 Aug 2014.

To cite this article: Jean-Claude Yazbek M.D. Psychiatrist, Ramzi Haddad M.D., Rami Bou Khalil M.D., Sani Hlais M.D.,Grace Abi Rizk M.D., Jihane Rohayem M.D. & Sami Richa M.D. Ph.D. (2014): Prevalence and Correlates of Alcohol Abuse andDependence in Lebanon: Results from the Lebanese Epidemiologic Survey on Alcohol (LESA), Journal of Addictive Diseases,DOI: 10.1080/10550887.2014.950026

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Prevalence and Correlates of Alcohol Abuse and Dependence in Lebanon: Results from the

Lebanese Epidemiologic Survey on Alcohol (LESA)

Running Head: The Lebanese Epidemiologic Survey on Alcohol (LESA)

Jean-Claude Yazbek, M.D.; Ramzi Haddad, M.D.; Rami Bou Khalil, M.D.; Sani Hlais,

M.D.; Grace Abi Rizk, M.D.; Jihane Rohayem, M.D.; Sami Richa, M.D., Ph.D.

First author: Jean-Claude Yazbek, M.D., Psychiatrist, Department of Psychiatry, Saint-Joseph

University, Beirut, Lebanon ([email protected])

Second author: Ramzi Haddad, M.D., Department of Psychiatry, Saint-Joseph University,

Beirut ([email protected]).

Third author, corresponding author and reprints: Rami Bou Khalil, M.D., Department of

psychiatry at Saint Joseph University, Beirut, Lebanon, address: Psychiatric Hospital of the

Cross, Jal Eddib, P.O. Box 60096, Metn, Lebanon (email: [email protected];

Phone: 0096170946430)

Fourth author: Sani Hlais, M.D., Department of Family Medicine, Saint-Joseph University,


Fourth author: Grace Abi Rizk, M.D., Department of Family Medicine, Saint-Joseph

University, Beirut.

Fifth author: Jihane Rohayem, M.D., Department of Psychiatry, Saint-Joseph University, Beirut

([email protected]).

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Sixth author: Sami Richa, M.D., Ph.D., Department of Psychiatry, Saint-Joseph University,


Abstract

Purpose: Determining the 12-months prevalence and correlates of DSM-IV alcohol abuse and

dependence in a nationally representative sample of Lebanese adults. Methods: 1000

participants collaborated in face-to-face interviews in 2011. Results: Prevalence of 12-months

alcohol dependence was 5.00% with a higher risk for men, unmarried, youngest adults, students,

participants with a liberal occupation, participants with low income, participants with positive

family history of alcohol misuse and smokers. Prevalence of 12-months alcohol abuse was

6.20% with a higher risk for men, students, employees and Druze and Christians as compared to

Muslims. Conclusions: Current alcohol abuse and dependence were found to be very highly

prevalent in Lebanon.

Keywords: Alcohol abuse and dependence; epidemiology; public health in Lebanon; Alcohol

Use Disorder Identification Test (AUDIT); Mini-International Neuropsychiatric Interview

(MINI).

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I- Introduction

Alcoholic beverages have been ubiquitarily consumed by human beings since the

beginning of times 1-2

. The use of this substance has not ceased to evoke various kinds of

emotions and of reactions because it is socially associated with pleasure in spite of having the

potential to induce a state of addiction that can become very harmful to the drinker and to his

surroundings 3. Alcohol use disorders (AUDs or “alcoholism”) refer to alcohol abuse and alcohol

dependence. These are maladaptive patterns of alcohol consumption causing many problems that

result in significant impairment or distress 4-5

. Alcohol use disorders are among the most

common psychiatric conditions in the Western countries 3, 6

. They are of special concern to

psychiatrists not only because they are widespread and frequent but also because they impose

major losses to individuals as well as to societies at large 7-19

.

Information regarding the epidemiology of alcohol is crucial for the elaboration of

etiological hypotheses that could lead to the discovery of biopsychosocial causes of

“alcoholism”. In addition, up-to-date descriptive epidemiologic work is considered important for

informing the public health system of treatment needs and of prevention requirements 3, 6, 20

.

Several wide-scale psychiatric epidemiologic surveys have already been undertaken in various

countries especially since the 1970’s 6-8, 10, 13, 16, 20-32

. Nonetheless, not all the studies have

specifically focused on the disorders related to alcohol use neither did they use the same

diagnostic criteria, or methods, or screenin tools 6, 33

. Major United States, European and

Lebanese studies comprise the landmark Epidemiologic Catchment Area (ECA) survey 25, 26

, the

National Comorbidity Survey Replication (NCS-R) 22, 27-30

, the National Epidemiologic Survey

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on Alcohol and Related Conditions (NESARC) 6, the European Study of the Epidemiology of

Mental Disorders (ESEMeD) 7, 31

, and the Lebanese Evaluation of the Burden of Ailments and

Needs Of the Nation (LEBANON) study 32

(for further details see table 1). Concerning 12-

months prevalence rates, the rate of alcohol abuse ranged from 0.7% (ESEMeD) 7, 31

to 4.7%

(NESARC) 6; the rate of alcohol dependence ranged from 0.3% (ESEMeD and LEBANON)

7, 31,

32 to 3.8% (NESARC)

6. Prior to the NCS-R (which was based on DSM-IV criteria), other

studies had reported prevalence rates for alcohol use disorders based on older versions of the

DSM (such as DSM-III-R) and their results had fallen within the following ranges: current

prevalence of alcohol abuse was 1.0% to 4.7% and of alcohol dependence 3.0% to 7.2% 10, 16, 21-

23. Furthermore, based on DSM-IV criteria, some studies (other than the NESARC) have also

reported a wide range of percentages as follows: current prevalence of alcohol abuse was 1.9% to

4.3% and of alcohol dependence 3.6% to 4.4% 8, 13, 20, 24

.

No psychiatric epidemiologic study has been performed in the Arab world. Moreover, no

nationally representative study that specifically tackles the issue of alcohol use disorders – in

their prevalence and their correlates - has been undertaken in Lebanon 32

. Because alcohol could

indeed constitute a major public health issue, and because many aspects of its epidemiology are

still quite obscure in the Oriental world, we have chosen to launch a nationwide epidemiologic

study in Lebanon that we have called the Lebanese Epidemiologic Survey on Alcohol (LESA).

II- Methods

LESA has been designed to fulfill multiple objectives related to the prevalence of alcohol use

disorders and to the various correlates suspected of being possibly associated with such diseases.

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The study has been funded by the research department of the Saint Joseph University of Beirut

after being approved by the Ethics Committee of the University.

II.a - Sample

A large nationwide cross-sectional survey has been performed throughout the month of

April 2011 upon a representative sample of the Lebanese general population aged between 18

and 64 years. The nationally representative sample was based on proportional probability

sampling (PPS) where the cluster was taken into consideration and the primary sampling unit

(PSU) was considered as a bloc of households. The interviewees were uninstitutionalized adults

lacking cognitive or physical impairements that might alter the quality of their participation. The

sampling and surveying procedures were carried out by Statistics Lebanon - a Lebanese firm

specialized in this kind of endeavors. The face-to-face interviews were all launched after insuring

appropriate informed consent for participation. In order to estimate the sample-size, the

following formula has been used 34

:

2

2 )1(

d

PPZN

N= the sample size

Z = the statistic coefficient for a classical confidence interval of 95% (Z=1.96)

P = the estimated prevalence of the alcohol-disease, as a ratio (proportion)

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d = the precision

Ten trained interviewers who formed two teams carried out the fieldwork. In total, they

approached 1265 individuals among whom 265 (20.95% of 1265) refused to participate. The

total sample was made of 1000 respondents which was approximately equivalent to the target

sample size of 1009. The response rate was 79.05%.

II.b- The screening test: the Alcohol Use Disorder Identification Test or AUDIT

The AUDIT has been developed by researchers appointed by the WHO as a brief

screening instrument for hazardous and harmful alcohol consumption 35-38

. The classical cut-off

score used to identify an alcohol-related problem is eight 36, 38, 39

. Authors have found that a cut-

off value of eight yielded sensitivities that were generally in the mid 0.90’s. Specificities across

countries and across criteria averaged in the 0.80’s 36, 38, 39

. In addition, Babor et al. affirmed that

the AUDIT can be used by non-health professionals with appropriate instructions 36

. The Arabic

Version of the AUDIT was the first of its kind to be proposed and used in simple conventional

Arabic language. Only one translation of the AUDIT had been performed in the Arab world (in

Dubai) 40

. However, the aforementionned translation cannot be used outside its country of origin

because it was done in a country-specific dialect that is not understandable in the other Arab-

speaking regions.

The Arabic AUDIT that was used in the LESA study had been produced in a systematic

way: First, a translation into Arabic by an expert translator from USJ has been performed,

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together in coordination with a bilingual alcohol-expert psychiatrist; Second, a reverse

translation of this first Arabic draft has been worked through by another independent

professional translator; Third, a board of four bilingual psychiatrist-experts worked on the

resolution of eventual divergences between the two forms of the translated test; Fourth, a final

review has brought about the last version of the Arabic AUDIT.

II.c- The diagnostic tool: the alcohol-related part of the Mini-International Neuropsychiatric

Interview or M.I.N.I.

The MINI is a short structured diagnostic interview that was developed in 1990 41

. It uses

decision tree logic to assess the major Axis I psychiatric disorders described in both DSM-IV

and the tenth edition of the International classification of diseases (ICD-10). The M.I.N.I. turned

out to be a short, handy and accurate evaluation tool for use in clinical trials and in

epidemiological studies 41-47

. Nevertheless, the only Arabic version of the MINI that is found in

the literature is in Moroccan dialect and is not understandable by other Arabic-speaking

populations 48

.Accordingly, the four steps in translating the MINI were the same as the ones used

for the AUDIT.

II.d- Statistics

Upon accomplishment of the data entry, the results were cross-tabbed and then analyzed

(by use of the SPSS software) in two ways. The first way pertained to descriptive statistics:

prevalence estimates were calculated and expressed in percentages with standard errors (SE).

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The second way of analysis was related to inferential statistics. For the purpose of inferential

statistical analysis, socio-demographic and other similar characteristics were considered as

independent variables. The statistical significance of each independent variable to the predictive

model was determined by Wald Chi-square (χ2) statistics. Tests like Analysis of Variance

(ANOVA), Student t-test, Pearson correlation, and Odds Ratio (with Confidence Intervals)

computation were also used where pertinent. Statistical significance was judged as p<0.05 (95%

level of significance). Also by means of inferential analysis, calculation of sensitivity and

specificity (with Confidence Interval) for the Arabic AUDIT test was produced.

III- Results

III.a- Socio-demographic and other pertinent characteristics of the respondents

The characteristics of the sampled population are presented in Table 2.

III.b- Results of the MINI interview

According to the MINI, the 12-months prevalence of alcohol dependence was 5.00%

(CI= 3.65%, 6.35%), the 12-months prevalence of alcohol abuse was 6.20% (CI= 4.71%, 7.69%)

and the 12-months prevalence of alcohol use disorders was 11.20% (SE= 0.997). Odds ratios

(OR) of alcohol dependence were significantly greater among men; among participants aged

between 18 and 34 years old as compared with participants aged between 50 and 64 years old;

among single participants as compared to married ones; among participants without any job as

compared to unemployed participants or housewives; among participants with a liberal

occupation as compared to those unemployed or housewives; among participants with a family

income of 500$-1000$ as compared to those whose family income is greater than 3000$/month;

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among participants with a positive family history of alcohol use disorder; and finally among

smokers. OR of alcohol abuse were greater among men; among students (with or without a job),

employees, or participants with a liberal occupation when each subgroup was compared to the

subgroup of unemployed participants or housewives; among participants belonging to Druze

confession as compared to participants belonging to Islam; and finally among Christian

participants compared to participants belonging to Islam (for more details refer to tables 3 and 4).

IV- Discussion

According to LESA, 11.2% of Lebanese adults experienced alcohol use disorders in the prior

12-months (6.2% abuse, 5% dependence) in 2011. LESA estimates were considerably higher

than the prevalence estimates from the LEBANON study 32

. The latter survey had found a 1.5%

prevalence of alcohol use disorders (1.2% abuse, 0.3% dependence). The authors had highlighted

their strong beliefs that their estimates were lower than the true prevalence rates of the

population 32

. LESA estimates were also considerably higher than the European prevalence

figures reported by the ESEMeD (alcohol use disorders 1%, abuse 0.7%, dependence 0.3%).

Nonetheless, the ESEMeD investigators had also said that their results were probably

conservative 7, 31

. The LESA results were closest to the ones of the NESARC study where the

prevalence of alcohol use disorders was 8.5% (4.7% abuse and 3.8% dependence). NESARC

reported that the results of previous United States studies were probably underestimates of true

rates and that their results, despite the relatively higher figures, were also probably

underestimates since the bulk of the encountered biases tended to pull estimates downward (eg,

sampling bias etc.) 6. No solid conclusions can be drawn by comparing LESA results with all

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these studies done in different countries and time frames. Many differences related to sampling

methods, age ranges, diagnostic systems, measuring tools, cultural variations and time frames are

present among these various surveys 6-8, 10, 13, 16, 22, 23, 25, 28, 31, 32, 49-51

. LESA results appeared quite

similar to some of those studies although similarities with previous studies cannot be over

interpreted. When it comes to the correlates and possible risk factors for alcohol disorders,

several variables have been identified.

Consistent with previous studies, men were at greater risk of alcohol use disorders than

women 6-8, 52

. However, OR were very high as compared to those found in other studies. OR for

alcohol use disorders was 11.82 (NESARC’s odds concerning different alcohol disorders were

between 2 and 3) 6, OR for abuse was 5.79 and that for dependence was too high to be calculated

since the prevalence of dependence among Lebanese women was found to be zero. The latter

result was certainely a major underestimation that came as such for various reasons such as: the

under-representation of women among respondents, cultural and / or religious norms and values

rendering women less at ease in reporting embarrassing or prohibited (alcohol consumption is

“religiously prohibited” in Islam) behaviors etc.

Consistent with previous studies, a trend for increased risk for alcohol use disorders with

decreasing age has been made evident in the LESA 6-8

. Nonetheless, the increased risk was

statistically significant only for dependence (and any alcohol use disorder) and only when

comparing the 18-34 age range subgroup to the 50-64 age range one.

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Single participants were at higher risks of suffering from dependence (compared to married

participants). This was in concordance with the literature where unmarried people were

consistently more at risk for alcohol disorders than married people 6-8

.

Dissimilarities with previous surveys were evident for occupation and associated risk for

alcohol disorders. LESA reported a lower risk for alcohol disorders among unemployed adults,

whereas previous international studies had repeatedly shown that unemployment was a risk

factor for alcohol use disorders 7,8

. Adults with a job were at a higher risk of alcohol abuse and of

any AUD. Students without any job and adults with a “liberal” occupation displayed higher odds

of dependence than unemployed adults. In the literature, being a student had sometimes been

presented as a risk factor for AUD (eg, the Australian survey) 8. However, the results concerning

the lower rate of alcohol disorders among the unemployed were unique to the LESA study. A

possible explanation is that in this part of the world unemployed adults are often taken care of by

their families. Furthermore, Lebanese adults who state they have a “liberal” occupation do not

always mean that they are currently having regular and sufficient income.

Religion and confession continue to play a significant role in the way the Lebanese

population identify its norms, values and behaviors. A higher risk for abuse (and for any AUD)

was observed among Druze and Christians when each subgroup was compared to Muslims.

However, no difference was noted when it came to dependence. The religious factor was not

studied in the before-mentioned large epidemiological surveys in relation to alcohol use.

Nonetheless, a study done by Button et al. in 2010 showed that religiosity appears to moderate

the genetic effects on problem alcohol use during adolescence, but not during early adulthood. It

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appeared to researchers that the decreased genetic variance for alcohol misuse in adolescence

may be due to the greater social control in adolescence than in young adulthood 53

.

Adults with a family income of 500$-1000$ compared to those whose family income was

greater than 3000$/month showed a greater risk only for dependence. This pattern was quite

consistent with what has been described in the NESARC: poor people were more at risk of

dependence and they were less at risk of abuse 6. Nonetheless, family monthly income is not a

very good predictor of wealth-status because it does not consider the income per capita.

Adults having a family member thought to suffer from alcohol problems were at a higher risk

of dependence (and of AUDs). These findings could be considered consistent with the literature

that has repeatedly emphasized the increased prevalence of positive family history of AUDs

among individuals who suffer from alcohol dependence 54-63

. Numerous rigorous - family, twin,

and adoption - studies have already pointed out the importance of genetic and environmental

factors in the etiology of alcoholism (mainly alcohol dependence) and have estimated that the

heritability for this disease is quite high (50-60%) 55-59, 62, 63

. A study done by Prescott et al. in

2005 has confirmed prior studies’ conclusions of strong genetic influences on alcoholism in men,

but has suspected lower genetic influence in women 57

.

Smoking was strongly associated with alcohol dependence (OR of 5.08) and with AUDs.

This finding was consistent with previous studies, such as the NESARC survey 6 and the

Collaborative Study on the Genetics of Alcoholism (COGA) 64

. Smoking and alcohol

dependence frequently co-occur, and the genetic factors that influence both conditions appear to

overlap. The COGA has investigated genetic factors that contribute to both alcohol dependence

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and habitual smoking. It has suggested that both common and drug-specific genetic influences

play a role in the development of alcohol and nicotine dependence 64

.

Finally, no association was found between AUDs and exposure to at least one war-related

traumatic event.

Several limitations were inherent to the LESA. The prevalence estimates were relatively high

when compared to previous epidemiological works 7-8, 25, 27, 32

. The first set of limitations was due

to the properties of the target population. The Lebanese population is not used to public opinion

research endeavors 32

. Despite declarations of anonymity and confidentiality, the will to

participate in the survey and the motivation to be completely sincere and to actively search for

precise answers were not always present. For instance, the non-response rate was 20.95%, with

women being most reluctant to participate. For cultural, social, and sometimes for religious

reasons, the reporting of behaviors pertaining to alcohol use was frequently seen as embarrassing

and unwelcomed 51

. A second set of limitations was due to the cross-sectional structure 6. This

kind of approach cannot detect any change of diagnoses over time, and it cannot guarantee

enough representation of diseased people -especially for uncommon disorders. A direct

consequence was the absence of detection of any alcohol-dependent woman in the entire sample.

The sampling process itself brought about many biases because of the way respondents were

selected. By all means, people with a history of mental illness are less prone to participate in

surveys either because of an even greater reluctance to cooperate 31, 65-67

, sample frame exclusion

(eg, excluding people with no homes, those with major handicaps etc.) 27, 31

, differential

mortality (especially in the Lebanese society whereby people with both major illnesses and lack

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of familial support have very little access to proper health care etc.), and high level of associated

stigma to display their characteristics (mental illnesses and especially substance misuse disorders

are still very stigmatized in Lebanon) 27, 31, 32, 68, 69

. Finally, another important limitation was that

the Arabic translations of the AUDIT and of the MINI have not been officially validated yet.

V- Conclusion

In summary, the LESA study has demonstrated that AUD were highly prevalent among the

Lebanese general population. It has identified population subgroups at particular risk and

unveiled many findings that deserve to be further investigated. By treating the substance misuse

symptoms before full-blown alcohol use disorder sets in, and by reducing the already identified

risk factors, the percentage of individuals who will ever develop serious disorders can be

favorably altered 7. Accordingly, a systemic preventive action that targets the Lebanese

population is needed. This action shall encompass educating the public and the governmental

organizations about the AUD consequences.

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Acknowledgment

We are grateful to Elsa Yazbek Charabati and to her team for the translation of all the parts of

the questionnaire used in the LESA– including the AUDIT and MINI.

We also thank Dr André Yazbek (Professor in gastroenterology) and Dr Elvire el-Hage-Chahine

Yazbek for their suggestions concerning the writing of the questionnaires and of the study.

Financial Disclosure: None reported.

Funding/Support: The Research Department of the Saint-Joseph University of Beirut (USJ) has

provided funds for the collection, management and analysis of the data. The design and the

conduct of the study, as well as the preparation, writing, reviewing and approval of the

manuscript were not supported by any fund or grant; they were the work and the responsibility of

the authors (and mostly of the first author).

No researcher had any connection with the tobacco, alcohol, pharmaceutical or gaming industries

or any body substantially funded by one of these organisations. No contractual constraint on

publishing was imposed by the funder.

The first author takes the responsibility for the integrity of the data and the accuracy of the

analyses. He confirms that all authors had full access to all the data in the study.

Conflict of Interest: The authors report no conflict of interest, financial affiliation or other

relationship relevant to the subject matter of this article.

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Table 1. Prevalence (%) of Alcohol Use Disorders According to Large-Scale Surveys

Name of the

study

Location Time Number of

participants

(N)

12-month

prevalence

of alcohol

abuse

12-month

prevalence

of alcohol

dependence

12-month

prevalence

of any

alcohol use

disorder

lifetime

prevalence

of alcohol

abuse

lifetime

prevalence

of alcohol

dependence

lifetime

prevalence

of any

alcohol use

disorder

ECA USA Late

1970’s

early

1980’s

20 ,291 6-month

rate= 1.9

6-month

rate= 2.8

6-month

rate= 4.8

5.6 7.9 13.5

NCS-R USA 2001-

2003

9,282 3.1 1.3 4.4 13.2 5.4 18.6

NESARC USA 2001-

2002

43,093 4.7 3.8 8.5 17.8 12.5 30.3

ESEMeD Europe 2001-

2003

21,425 0.7 0.3 1.0 4.1 1.1 5.2

LEBANON Lebanon 2002-

2003

2,857 1.2 0.3 1.5 - - -

Notes: - Prevalence refers to the prevalence rate of the disorder and is given in percentage (%)

- ECA = Epidemiologic Catchment Area survey

- NCS-R = Nat ional Comorbid i ty Survey Repl icat ion

- NESARC = National Epidemiologic Survey on Alcohol and Related Conditions

- ESEMeD = European Study of the Epidemiology of Mental Disorders

- LEBANON = Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation

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Table 2. Socio-demographic and other pertinent characteristics of the respondents

Characteristics of Alcohol Respondents

% SE Total Number

Gender

Male 67.9 1.48 679

Female 32.1 1.48 321

Age, in years

18-34 45.5 1.57 455

35-49 30.2 1.45 302

50-64 24.3 1.36 243

Mean 38.01 (CI= 37.14-38.88)

Marital status

Single 39.1 1.54 391

Married 58.5 1.56 585

Widowed 1.1 0.33 11

Divorced 1.3 0.36 13

Occupation

Liberal 46.7 1.58 467

Employee 33.5 1.49 335

Unemployed or House wife 12 1.03 120

Student without any job 4.9 0.68 49

Student with a job 2.9 0.53 29

Academic level

None 2.3 0.47 23

Primary schooling 19.3 1.25 193

Complementary schooling 34.2 1.5 342

Secondary schooling 22.5 1.32 225

Technical formation 7.3 0.82 73

University 14.4 1.11 144

Religion

Christian 38.7 1.54 387

Muslim 54.4 1.58 544

Druze 6.9 0.8 69

Familial monthly income, in $

<500$ 3.2 0.56 32

500$-1000$ 37.6 1.53 376

1000$-3000$ 50.8 1.58 508

>3000$ 8.4 0.88 84

Having a family member thought to suffer from alcohol problem

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Yes 8.2 0.87 82

No 91.8 0.87 918

Smoking

Yes 60.5 1.55 605

No 39.5 1.55 395

Physical exercise

Not at all 35.7 1.52 357

Occasionally 36 1.52 360

Often 10.7 0.98 107

Daily 17.6 1.20 176

Exposure to war-related traumatic events

Yes 76.0 1.35 760

No 24.0 1.35 240

Geographical location

Beirut 10.0 0.95 100

Mount Lebanon 35.3 1.51 353

North 20.3 1.27 203

South 20.8 1.28 208

Bekaa 13.6 1.08 136

Usual place of drinking

At home and alone 13.6 1.08 91

At home with other drinkers 35.3 1.51 237

At other people's home 4.9 0.68 33

In restaurants 40.8 1.55 274

In other public places such as pubs, bars or discotheques 5.4 0.71 36

Seeking help to stop drinking

Yes 0.9 0.30 6

No 99.1 0.30 665

Number of persons in the household

Mean= 4.513 ~ 5

Mode= 4.00; Std. Deviation= 1.96; Minimum= 1.00; Maximum= 16.00

Number of rooms in the house

Mean= 4.125 ~ 4

Mode= 3; Std. Deviation= 1.57; Minimum= 1; Maximum= 12

Age at first drinking, in years

Mean= 19.51

Mode= 20.00; Std. Deviation= 5.23; Minimum= 10.00; Maximum= 60.00

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Table 3. 12-Months Prevalence of DSM-IV Alcohol Use Disorders According to Different

Characteristics of the Respondents

Alcohol Use Disorder

(n = 112)

Alcohol Dependence

(n = 50)

Alcohol Abuse

(n = 62)

% SE % SE % SE

Total 11.2 0.997 5 0.689 6.2 0.763

Gender*

Male 15.76 1.152 7.36 0.826 8.39 0.877

Female 1.56 0.392 0 0 1.56 0.392

p-value of the trend test (Chi-square) 0.000++ 0.0000++ 0.000++

Age, in years

18-34 13.41 1.078 6.59 0.785 6.81 0.797

35-49 10.93 0.987 4.3 0.641 6.62 0.786

50-64 7.41 0.828 2.88 0.529 4.53 0.658

p-value of the trend test (ANOVA) 0.056 0.081 0.142

Marital status

Single 13.04 1.065 6.65 0.788 6.39 0.773

Married 10.26 0.96 3.93 0.614 6.32 0.769

p-value of the trend test 0.179 0.057 0.161

Widowed 0 0 0 0 0 0

Divorced 7.69 0.843 7.69 0.843 0 0

Occupation*

Liberal 14.78 1.122 6.64 0.787 8.14 0.865

Employee 7.76 0.846 3.28 0.563 4.48 0.654

Unemployed or House wife 2.5 0.494 1.67 0.405 0.83 0.287

Student without any job 20.41 1.275 10.2 0.957 10.2 0.957

Student with a job 13.79 1.09 3.45 0.577 10.34 0.963

p-value of the trend test 0.001+ 0.129 0.010+

Academic level*

None 4.35 0.645 4.35 0.645 0.00 0.000

Primary schooling 13.47 1.08 6.74 0.793 6.74 0.793

Complementary schooling 14.04 1.099 7.89 0.852 6.14 0.759

Secondary schooling 10.67 0.976 1.78 0.418 8.89 0.9

Technical formation 6.85 0.799 5.48 0.72 1.37 0.368

University 5.56 0.725 0.69 0.262 4.86 0.68

p-value of the trend test 0.001+ 0.001+ 0.010+

Religion*

Christian 12.92 1.061 4.91 0.683 8.01 0.858

Muslim 9.38 0.922 5.51 0.722 3.86 0.609

Druze 15.94 1.158 1.45 0.378 14.49 1.113

p-value of the trend test 0.104 0.343 0.002+

Family monthly income, in $

<500$ 9.38 0.922 3.13 0.551 6.25 0.765

500$-1000$ 10.37 0.964 6.12 0.758 4.26 0.639

1000$-3000$ 11.81 1.021 4.72 0.671 7.09 0.812

>3000$ 11.9 1.024 2.38 0.482 9.52 0.928


Having a family member thought to suffer from alcohol problems*

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Yes 20.73 1.28 14.63 1.12 6.1 0.76

No 10.35 0.96 4.14 0.63 6.21 0.76

p-value of the trend test 0.004+ 0.000++ 0.000++

Smoking*

Yes 14.38 1.11 7.27 0.82 7.11 0.81

No 6.33 0.77 1.52 0.39 4.81 0.68

p-value of the trend test 0.000++ 0.000++ 0.000++

Physical exercise

Not at all 12.89 1.06 5.32 0.71 7.56 0.84

Occasionally 10.00 0.95 3.89 0.61 6.11 0.76

Often 7.48 0.83 3.74 0.60 3.74 0.60

Daily 12.50 1.05 7.39 0.83 5.11 0.70



Yes 10.79 0.98 5.26 0.71 5.53 0.72

No 12.50 1.05 4.17 0.63 8.33 0.87


Geographical location

Beirut 8.00 0.86 2.00 0.44 6.00 0.75

Mount Lebanon 9.63 0.93 3.12 0.55 6.52 0.78

North 21.18 1.29 10.84 0.98 10.34 0.96

South 3.85 0.61 1.92 0.43 1.92 0.43

Bekaa 13.97 1.10 8.09 0.86 5.88 0.74

Usual place of drinking

At home and alone 18.68 1.23 6.59 0.78 12.09 1.03

At home with other drinkers 11.81 1.02 4.22 0.64 7.59 0.84

At other people's home 18.18 1.22 6.06 0.75 12.12 1.03

In restaurants 17.88 1.21 8.39 0.88 9.49 0.93

In other public places such as pubs, bars or

discotheques 33.33 1.49 25.00 1.37 8.33 0.87

Seeking help to stop drinking

Yes 16.67 1.18 16.67 1.18 0.00 0.00

No 16.69 1.18 7.37 0.83 9.32 0.92

* means that characteristic is associated with alcohol dependence, alcohol abuse, or both

disorders.

+ means that p-value is less than 0.05

++ means that p-value is less than 0.001

Note: no analysis for trend for the last 3 characteristics was performed.

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Table 4. Unadjusted Odds Ratios of 12-Month DSM-IV Alcohol Use Disorders by Different

Characteristics of the Respondents

Characteristic Alcohol Use Disorder Alcohol Dependence Alcohol Abuse

Gender

Male 11.82 (10.92-12.73)** Too large to calculate # 5.79 (4.87-6.72)**

Female 1.00 [Reference] 1.00 [Reference] 1.00 [Reference]

Age, in years

18-34 1.94 (1.38-2.49)** 2.38 (1.54-3.22)** 1.54 (0.84-2.25)

35-49 1.53 (0.93-2.13) 1.52 (0.58-2.45) 1.50 (0.74-2.25)

50-64 1.00 [Reference] 1.00 [Reference] 1.00 [Reference]

Marital Status

Single 1.31 (0.92-1.71) 1.74 (1.16-2.32)** 1.01 (0.49-1.54)

Married 1.00 [Reference] 1.00 [Reference] 1.00 [Reference]

Widowed # #

Divorced 0.73 (-1.33-2.79) 0.85 (-1.22-2.93) # #

Occupation

Student without any job 10.00 (8.66-11.34)** 6.70 (5.03-8.38)** 13.52 (11.35-15.70)**

Student with a job 6.24 (4.68-7.80)** 2.11 (-0.33-4.54) 13.73 (11.43-16.03)**

Unemployed or House wife 1.00 [Reference] 1.00 [Reference] 1.00 [Reference]

Employee 3.28 (2.07-4.5)** 2.00 (0.48-3.52) 5.58 (3.54-7.61)**

Liberal 6.76 (5.59-7.94)** 4.19 (2.75-5.64)** 10.54 (8.54-12.54)**

Academic Level

None 0.29 (-1.75-2.34) 0.63 (-1.45-2.71) ##

Primary schooling 1.00 [Reference] 1.00 [Reference] 1.00 [Reference]

Complementary schooling 1.05 (0.53-1.56) 1.19 (0.5-1.87) 0.91 (0.19-1.62)

Secondary schooling 0.77 (0.18-1.36) 0.13 (-1.38-1.63) 1.35 (0.62-2.08)

Technical formation 0.47 (-0.53-1.47) 0.81 (-0.35-1.96) 0.19 (-1.86-2.24)

University 0.81 (-0.09-1.72) 0.10 (-1.95-2.14) 0.71 (-0.24-1.65)

Religion

Christian 1.43 (1.02-1.85)** 0.88 (0.29-1.47) 2.17 (1.60-2.74)**

Muslim 1.00 [Reference] 1.00 [Reference] 1.00 [Reference]

Druze 1.83 (1.13-2.54)** 0.25 (-1.76-2.26) 4.22 (3.42-5.02)**

Family monthly income, in $

<500$ 0.77 (-0.59-2.13) 1.32 (-1.11-3.76) 0.63 (-0.97-2.24)

500$-1000$ 0.86 (0.12-1.60) 2.67 (1.21-4.14)** 0.42 (-0.46-1.31)

1000$-3000$ 0.99 (0.28-1.7) 2.03 (0.57-3.49) 0.72 (-0.08-1.53)

>3000$ 1.00 [Reference] 1.00 [Reference] 1.00 [Reference]

Having a family member thought to suffer from alcohol problem

Yes 2.27 (1.69-2.84)** 3.97 (3.28-4.66)** 0.98 (0.04-1.92)

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ACCEPTED MANUSCRIPT


No 1.00 [Reference] 1.00 [Reference] 1.00 [Reference]

Smoking

Yes 2.49 (2.02-2.95)** 5.08 (4.22-5.95)** 1.51 (0.96-2.07)

No 1.00 [Reference] 1.00 [Reference] 1.00 [Reference]

Physical exercise

Not at all 1.00 [Reference] 1.00 [Reference] 1.00 [Reference]

Occasionally 0.75 (0.29-1.21) 0.72 (0.01-1.43) 0.80 (0.21-1.38)

Often 0.55 (-0.24-1.33) 0.69 (-0.41-1.79) 0.47 (-0.60-1.55)

Daily 0.97 (0.42-1.51) 1.42 (0.69-2.15) 0.66 (-0.12-1.44)


Yes 1.00 [Reference] 1.00 [Reference] 1.00 [Reference]

No 1.18 (0.74-1.63) 0.78 (0.07-1.49) 1.55 (1.00-2.11)

a Unadjusted Odds Ratios (with their 95% Confidence Intervals put between brackets)

** Odds Ratio was significant

# Odds Ratio could not be computed because the prevalence of disease (dependence) in the

reference-subgroup (female) was zero

## Odds Ratio was not presented because the prevalence of the corresponding disease in the

subgroup was zero

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prevalence and correlates of alcohol abuse and dependence in lebanon: results from the lebanese...

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